Laserfiche WebLink
Environmental Health Services Division <br />~{~rion County Dep~ctmcmt of Public Hea].th <br />Sa]em, Oregon 97301 (588-5[F_%)~ ~en~ for: <br />Departz.,~ent of Enviro~nentr:tl Quality <br /> <br />To be submitted with application for <br />builddng pe3m~iZ or mobile home place- <br />ment permit. <br /> <br />Application to the D~D~:~,mt of Enviror~mmta! C~ality <br /> for a Pe_~nit to ConstrUct a New or ~F~air <br /> a Subsurface S~e Disposal <br /> <br />Permit <br /> <br />New - $50.00 ($~o. OOwith site evaluation) <br /> <br />Alteration - $15.00 <br /> <br />Tax Lot or Account <br /> <br />Lot Size / ~' <br /> <br /> 2 <br />Property A~esS ~..4~/¢~.(_.)¢~ ~/A_~...) <br /> <br />Inst~l%~. N~Jne <br /> <br />B, (-~Vi~/LL DF~CRIPTI~Y <br /> <br />NmvConstruction <br /> <br />Repair <br /> <br />Installation will serve: House Mobile Home ~ Mobile Home Pe_rk <br /> <br />Cocmercial ~ui.lding Other (explain) <br />Number of Living Units N~ber of [~droc~,~ --_:~ <br /> <br />Water Sktpply: th~blic __ Cccmmity __ Private <br /> <br />Garb~4e Disposal? <br /> <br />1. Proposed Subsurface S~e Disposal Syst~n Plot <br /> <br />2. Pl~nning Evaluation -- Building Permit <br /> k~ailding Plums <br /> <br />I hereby certify tn~.t the infor~zation contain¢~l in this applic2.tfon is true and c~)rrec~ <br /> <br />to 'the bc ~'t of my knowledge add belief. <br /> <br />7/74 <br /> <br />r%lte <br /> <br /> <br />